A Clinical Guide to Assess the Role of Lower Limb Extensor Overactivity in Hemiplegic Gait Disorders

Yelnik, A.; Albert, Tim; Bonan, Isabelle; Laffont, I.

doi:10.1161/01.str.30.3.580

Cited by 64 publications

(34 citation statements)

References 27 publications

(31 reference statements)

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“…Following stroke, withdrawal reflexes in the upper-limb have been shown to produce an abnormal spatial distribution of torque (Dewald et al 1999) which was similar in nature to the constrained torque synergies seen during volitional arm movements (Dewald et al 1995). In the hemiparetic lower limb, the facilitation of quadriceps motoneurons following stimulation of the common peroneal nerve (Marque et al 2001b) and the facilitation of rectus femoris in the current study may reflect the abnormal activation of the quadriceps prior to and during the swing phase of gait (Yelnik et al 1999;Den Otter et al 2006).…”

Section: Functional Implicationssupporting

confidence: 59%

“…Biomechanical simulations investigating potential muscular contributions to this impaired knee flexion have revealed that it may be attributed to abnormal activation of the quadriceps (Piazza and Delp 1996;Riley and Kerrigan 1998;Goldberg et al 2004). Indeed, analysis of muscle activity during hemiparetic gait has revealed that abnormal activation of the quadriceps prior to and during the swing phase appears to be consistent across subjects (Yelnik et al 1999;Den Otter et al 2006). The goal of this study was to determine if there is evidence for a spinal contribution to this abnormal pattern of muscle activity following stroke.…”

Section: Introductionmentioning

confidence: 99%

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Stretch reflex coupling between the hip and knee: implications for impaired gait following stroke

2008

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Individuals with hemiparetic stroke often exhibit an abnormal coupling between the frontal plane of the hip and saggital plane of the knee during gait. The purpose of this study was to determine if stretch sensitive reflexes, which are known to be altered following stroke, exhibit similar coupling between the muscles of the hip and knee in the post-stroke population. Eighteen subjects were recruited for this study including ten with hemiparesis resulting from stroke and eight unimpaired, age-matched controls. A servomotor was used to apply ramp and hold perturbations to both the hip and knee joints in separate sessions and electromyographic activity was recorded in eight muscles of the lower limb. Hip abduction perturbations elicited abnormal activation in rectus femoris (RF) in seven of ten stroke subjects with amplitudes ranging from 3.2 to 12.5% of the maximum voluntary contraction (MVC). Only two of eight control subjects exhibited any activity in RF and these responses were only 2.1 and 2.7% of MVC. To determine if the responses in the stroke group were a result of muscle stretch, a musculoskeletal model was used to simulate the experimental abduction perturbations and estimate muscle length changes. The simulation revealed that RF should be shortened by the perturbations and this suggests that the response was not likely due to direct stretch. Moreover, knee flexion perturbations elicited responses in the hip adductors (AL) with a mean amplitude of 5.1 ± 3.8% of MVC across all stroke subjects while no significant responses were recorded in controls. The presence of a reciprocal, reflex-mediated coupling between RF and AL following stroke suggests

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Section: Functional Implicationssupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Stretch reflex coupling between the hip and knee: implications for impaired gait following stroke

2008

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“…In the present, population-based study, it is unlikely that we have underestimated the prevalence of spasticity: in the MAS, spasticity is equated with any measurable increase in velocity-dependent resistance to passive stretch – whether reflex mediated or not. However, regardless of the cause, the exact influence of spasticity on disability in stroke patients is difficult to assess, because the degree of spasticity may change with body position and with the task being performed [28]. Only 8% of the patients in the present study reported muscle stiffness, further underscoring the low prevalence of increased muscle tone in our cohort.…”

Section: Discussionmentioning

confidence: 67%

Spasticity and Its Association with Functioning and Health-Related Quality of Life 18 Months after Stroke

et al. 2006

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Background: There is no consensus concerning the presence of spasticity or the relationship between spasticity and functioning and spasticity and health-related quality of life (HRQL) in the stable phase after stroke. Objective: The aim of the present study was to describe, 18 months after stroke, the frequency of spasticity and its association with functioning and HRQL. Methods: In a cohort of 66 consecutive patients with first-ever stroke, studied prospectively, the following parameters were assessed 18 months after stroke: spasticity, by the Modified Ashworth Scale (0–4 points with 1+ as the modification), muscle stiffness, by self-report, abnormal tendon reflexes, by physical examination, motor performance, by the Lindmark Motor Assessment Scale, mobility, by the Rivermead Mobility Index, activities of daily living, by the Barthel Index, and HRQL, by the Swedish Short Form 36 Health Survey Questionnaire (SF-36). Results: Of 66 patients studied, 38 were hemiparetic; of these, 13 displayed spasticity, 12 had increased tendon reflexes, and 7 reported muscle stiffness 18 months after stroke. Weak (r < 0.5) to moderate (r = 0.5–0.75) correlations were seen between spasticity and functioning scores. Correlations between spasticity and HRQL were generally weak (r < 0.5). Hemiparetic patients without spasticity had significantly better functioning scores and significantly better HRQL on 1 of the 8 SF-36 health scales (physical functioning) than patients with spasticity. Conclusions: Few patients displayed spasticity 18 months after stroke. Spasticity might contribute to impairment of movement function and to limitation of activity, but seems to have a less pronounced effect on HRQL.

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“…Gait is a complex activity that relies on navigation and rhythmic motor activity of the 2 lower limbs and requires a good balance. In brain-damaged patients, the level of gait performance can be affected by many factors, such as impaired equilibrium (difficulty in controlling the orientation and/or stabilization of the body with respect to gravity), tone disorders, 33 and strength deficits. 34 For this reason, and in agreement with most other authors, 5-9,13,30,33-35 we chose to separate posture and gait assessments.…”

Section: Benaim Et Al Standardized Assessment Of Postural Control In mentioning

confidence: 99%

Validation of a Standardized Assessment of Postural Control in Stroke Patients

Benaïm

Pérennou

Villy

et al. 1999

Stroke

340

209

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Background and Purpose —Few clinical tools available for assessment of postural abilities are specifically designed for stroke patients. Most have major floor or ceiling effects, and their metrological properties are not always completely known. Methods —The Postural Assessment Scale for Stroke patients (PASS), adapted from the BL Motor Assessment, was elaborated in concordance with 3 main ideas: (1) the ability to maintain a given posture and to ensure equilibrium in changing position both must be assessed; (2) the scale should be applicable for all patients, even those with very poor postural performance; and (3) it should contain items with increasing difficulty. This new scale has been validated in 70 patients tested on the 30th and 90th days after stroke onset. Results —Normative data obtained in 30 age-matched healthy subjects are presented. The PASS meets the following requirements: (1) good construct validity: high correlation with concomitant Functional Independence Measure (FIM) scores ( r =0.73, P =10 −6 ), with lower-limb motricity scores ( r =0.78, P <10 −6 ), and with an instrumental measure of postural stabilization ( r =0.48, P <10 −2 ); (2) excellent predictive validity: high correlation between PASS scores on the 30th day and FIM scores on the 90th day ( r =0.75, P <10 −6 ); (3) high internal consistency (Cronbach α-coefficient=0.95); and (4) high interrater and test-retest reliabilities (average κ=0.88 and 0.72). Conclusions —Our results confirm that the PASS is one of the most valid and reliable clinical assessments of postural control in stroke patients during the first 3 months after stroke.

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A Clinical Guide to Assess the Role of Lower Limb Extensor Overactivity in Hemiplegic Gait Disorders

Cited by 64 publications

References 27 publications

Stretch reflex coupling between the hip and knee: implications for impaired gait following stroke

Stretch reflex coupling between the hip and knee: implications for impaired gait following stroke

Spasticity and Its Association with Functioning and Health-Related Quality of Life 18 Months after Stroke

Validation of a Standardized Assessment of Postural Control in Stroke Patients

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